The Use of Normothermic Regional Perfusion Increases The Burden of Organ Donation After Euthanasia

Post-mortem introduction of normothermic regional perfusion (NRP) is increasingly used in organ donation. In this procedure, after declaration of death according to circulatory-criteria and "no touch" time of 5 minutes, organ donors’ circulation is restored by extracorporeal membrane oxygenation (ECMO). Before restoring circulation during NRP, surgeons block arteries perfusing brain to avoid regaining of brain functions. The mechanics and set-up of NRP may difficult understand for patients and medical professionals alike. In addition, restoration of circulation puts permanence of circulatory death into question, especially in the context where blocking of arteries perfusing brain after death is already declared is considered necessary. An outsized role that autonomy and consent play for a growing number of euthanasia patients considering organ donation exacerbates these already significant issues. A planned nature of euthanasia donors’ death invites numerous perimortem interventions to optimize organ quality, with NRP joining an already long list of premortal donor interventions. The growing burden of donation in euthanasia patients increases the odds that patients and their families do not fully understand this process, and raises significant ethical and potentially legal questions